DENTAL HYGIENE ACT, 1991 / LOI DE 1991 SUR LES HYGIÉNISTES DENTAIRES
DENTAL TECHNOLOGY ACT, 1991 / LOI DE 1991 SUR LES TECHNICIENS DENTAIRES
DENTISTRY ACT, 1991 / LOI DE 1991 SUR LES DENTISTES
DENTURISM ACT, 1991 / LOI DE 1991 SUR LES DENTUROLOGUES
DIETETICS ACT, 1991 / LOI DE 1991 SUR LES DIÉTÉTISTES
MASSAGE THERAPY ACT, 1991 / LOI DE 1991 SUR LES MASSOTHÉRAPEUTES
CONTENTS
Tuesday 15 October 1991
Regulated Health Professions Act, 1991, and companion legislation / Loi de 1991 sur les professions de la santé réglementées et les projets de loi qui l'accompagnent
Dental Hygiene Act, 1991 / Loi de 1991 sur les hygiénistes dentaires
Dental Technology Act, 1991 / Loi de 1991 sur les techniciens dentaires
Dentistry Act, 1991 / Loi de 1991 sur les dentistes
Denturism Act, 1991 / Loi de 1991 sur les denturologues
Dietetics Act, 1991 / Loi de 1991 sur les diététistes
Massage Therapy Act, 1991 / Loi de 1991 sur les massothérapeutes
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
Chair: Caplan, Elinor (Oriole L)
Vice-Chair: Cordiano, Joseph (Lawrence L)
Beer, Charles (York North L)
Haeck, Christel (St. Catharines-Brock NDP)
Hope, Randy R. (Chatham-Kent NDP)
Malkowski, Gary (York East NDP)
Martin, Tony (Sault Ste Marie NDP)
McLeod, Lyn (Fort William L)
Owens, Stephen (Scarborough Centre NDP)
Wessenger, Paul (Simcoe Centre NDP)
Wilson, Jim (Simcoe West PC)
Witmer, Elizabeth (Waterloo North PC)
Clerk: Mellor, Lynn
Staff: Spakowski, Mark, Legislative Counsel
The committee met at 1605 in room 151.
REGULATED HEALTH PROFESSIONS ACT, 1991, AND COMPANION LEGISLATION / LOI DE 1991 SUR LES PROFESSIONS DE LA SANTÉ RÉGLEMENTÉES ET LES PROJETS DE LOI QUI L'ACCOMPAGNENT
Resuming consideration of Bill 43, the Regulated Health Professions Act, 1991, and its companion legislation, Bills 44-64.
Reprise de l'étude du projet de loi 43, Loi sur les professions de la santé réglementées et les projets de loi, 44 à 64, qui l'accompagnent.
DENTAL HYGIENE ACT, 1991 / LOI DE 1991 SUR LES HYGIÉNISTES DENTAIRES
The Chair: We are beginning now with Bill 47, An Act respecting the regulation of the Profession of Dental Hygiene.
Sections 1 and 2 agreed to.
Les articles 1 et 2 sont adoptés.
Section/article 3:
The Chair: Mr Wessenger moves that section 3 of the bill be amended by striking out "on the order of a member of the Royal College of Dental Surgeons of Ontario" in the fourth, fifth and sixth lines.
Mr Wessenger: This removes the reference to doing things on the order of a dentist and it is related to the amendment to section 4 which rephrases the order requirement for performance of authorized acts. It was not logically and necessarily part of the scope statement and the problem is, if it is left in, dental hygienists could potentially be prosecuted under the harm clause if they performed an authorized act without an order. The matter should really only be dealt with, disciplined by the college.
Motion agreed to.
Section 3, as amended, agreed to.
L'article 3, modifié, est adopté.
The Chair: I believe you have an amendment, Mr Beer.
Mr Beer: Yes, our proposed amendment can be withdrawn because of the amendment we just passed. It is similar.
Section/article 4:
The Chair: Mr Wessenger moves that section 4 of the bill be amended by striking out "on the order of a member of the Royal College of Dental Surgeons of Ontario" in the last three lines of paragraphs 1 and 2.
Mr Wessenger: This is related to section 4.1 and makes it clear that a dentist does not order a hygienist, the dentist orders a procedure.
Motion agreed to.
Section 4, as amended, agreed to.
L'article 4, modifié, est adopté.
The Chair: Mr Wessenger moves that the bill be amended by adding the following section:
"4.1(1) A member shall not perform a procedure under the authority of section 4 unless the procedure is ordered by a member of the Royal College of Dental Surgeons of Ontario.
"(2) In addition to the grounds set out in subsection 49(1) of the health professions procedural code, a panel of the discipline committees shall find that a member has committed an act of professional misconduct if the member contravenes subsection (1)."
Mr Wessenger: I think we have already covered this aspect to indicate that it is a breach if a hygienist performs a procedure without an order.
Motion agreed to.
Section 5 agreed to.
L'article 5 est adopté.
Section/article 6:
The Chair: Mr Wessenger moves that subsection 6(1) of the bill be amended,
(a) by striking out: "at least seven and no more than ten" in the first line of clause (a) and substituting "at least nine and no more than twelve";
(b) by striking out "at least four and no more than six" in the first line of clause (b) and substituting "at least eight and no more than eleven"; and
(c) by striking out "one or two" in the first line of clause (c) and substituting "two."
Mr Wessenger: This is to make sure that the council composition is just under half members.
Mr J. Wilson: We will be opposing this amendment as we believe it violates, to some degree, the principle of self-regulation.
Mr Hope: I believe we will be supporting this because it does allow the majority. It still holds 50 plus 1, which gives the right for self-government.
The Chair: Further debate? Shall the amendment carry? All those in favour of the amendment? Any opposed?
Motion agreed to.
Section 6, as amended, agreed to.
L'article 6, modifié, est adopté.
Section 7 agreed to.
L'article 7 est adopté.
Section/article 8:
The Chair: Shall section 8 carry? I know you have to vote against.
Mr Wessenger: We have to vote against.
The Chair: I understand the intention. The clerk advises me the correct wording is, shall section 8 stand as part of the bill? All those in favour? Those opposed?
Section 8 deleted.
L'article 8 est rayé.
The Chair: Just for the information of all committee members, a motion to delete is not in order so we have to ask if the section shall stand as part of the bill, given the changes to the previous section, rather than deleting sections 8 to 14 as we did in previous bills. This is a more correct way of dealing with it.
Sections 9 to 14, inclusive, deleted.
Les articles 9 à 14, inclusivement, sont rayés.
Mr Hope: A point of clarification, Madam Chair, on the way we did the other bills: Are they still valid under the proper process?
The Chair: If you will recall, Mr Hope, I requested unanimous consent from the committee to deal with the other bills, and according to the clerk that makes it valid because there was unanimous consent. I have been advised that according to parliamentary procedures the new wording we have used today would not require unanimous consent and is therefore a better way of proceeding.
Section/article 15:
The Chair: Mr Wessenger moves that subsection 15(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Mr Wessenger: The purpose of this, of course, is in accordance with all the other bills to take out the aspect of title protection being only in the course of providing health care.
Motion agreed to.
Section 15, as amended, agreed to.
L'article 15, modifié, est adopté.
Sections 16 and 17 agreed to.
Les articles 16 et 17 sont adoptés.
Section/article 18:
The Chair: Mr Wessenger moves that section 18 of the bill be amended by striking out "college" in the third line and substituting "council" and by striking out clause (c).
Motion agreed to.
The Chair: Mr Wessenger moves that clause 18(b) of the bill be amended by striking out "number" in the first line.
Mr Wessenger: This is merely a housekeeping change.
Motion agreed to.
Section 18, as amended, agreed to.
L'article 18, modifié, est adopté.
Sections 19 to 21, inclusive, agreed to.
Les articles 19 à 21, inclusivement, sont adoptés.
Section/article 22:
The Chair: Mr Wessenger moves that section 22 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
And that this should be stood down until October 21.
On the motion to stand down, all in favour? Any opposed?
Motion agreed to.
Section 22 deferred.
L'article 22 est différé.
Section 23 agreed to.
L'article 23 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: We have to hold the rest until we have dealt with section 22, which has been stood down.
DENTAL TECHNOLOGY ACT, 1991 / LOI DE 1991 SUR LES TECHNICIENS DENTAIRES
Section/article 1:
The Chair: Mr Wessenger moves that the French version of section 1 of the bill be amended,
(a) by striking out "techniciens" in the definition of "ordre" and substituting "technologues"; and
(b) by striking out "technicien" in the definition of "profession" and substituting "technologue."
Motion agreed to.
Section 1, as amended, agreed to.
L'article 1, modifié, est adopté.
Section/article 2:
The Chair: Mr Wessenger moves that the French version of subsection 2(2) of the bill be amended,
(a) by striking out "techniciens" in the definition of "ordre" and substituting "technologues"; and
(b) by striking out "technicien" in the definition of "profession" and substituting "technologue."
Motion agreed to.
Section 2, as amended, agreed to.
L'article 2, modifié, est adopté.
Section/article 3:
The Chair: Mr Wessenger moves that section 3 of the bill be amended by striking out "on the order of a person authorized under a health profession act as defined in the Regulated Health Professions Act, 1991 to fit or dispense the devices" in the last four lines.
Do you have another amendment as well to section 3?
Mr Wessenger: No, I believe the other one is being withdrawn.
The Chair: Okay. Is there any discussion on this amendment?
Motion agreed to.
Section 3, as amended, agreed to.
L'article 3, modifié, est adopté.
Section/article 4:
The Chair: Mr Wessenger moves that the English version of section 4 of the bill be amended by striking out "techniciens" in the fourth line and substituting "technologues."
And he further moves that the French version of section 4 of the bill be amended by striking out "techniciens" in the third line and substituting "technologues."
Motion agreed to.
Section 4, as amended, agreed to.
L'article 4, modifié, est adopté.
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Section/article 5:
The Chair: Mr Wessenger moves that clause 5(1)(a) of the bill be struck out and the following substituted:
"(a) seven persons who are members elected in the prescribed manner; and"
And he further moves that clause 5(1)(b) of the bill be amended by striking out "at least four and no more than six" in the first line and substituting "six."
Mr J. Wilson: I will be voting against this section because we do believe that the government's proposal to have the number of lay members on council to just under 50% does erode the principle of self-regulation.
The Chair: Further discussion on the amendment?
Mr J. Wilson: Mr Hope has his usual line.
The Chair: Did you want to repeat that again?
Mr Hope: No -- my usual line.
Motion agreed to.
Section 5, as amended, agreed to.
L'article 5, modifié, est adopté.
Section 6 agreed to.
L'article 6 est adopté.
Section/article 7:
The Chair: My wording is going to be a little different in light of the amendment to section 5. Shall section 7 stand as part of the bill? All those in favour? Any opposed?
Section 7 deleted.
L'article 7 est rayé.
Sections 8 to 13, inclusive, deleted.
Les articles 8 à 13, inclusivement, sont rayés.
Section/article 14:
The Chair: Mr Wessenger moves that subsection 14(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Mr Wessenger: Again, this amendment is to carry out the title provision beyond the provision of health care.
The Chair: All those in favour? Any opposed?
Motion agreed to.
The Chair: Mr Wessenger moves that the French version of subsection 14(1) of the bill be amended by striking out "technicien" in the second line and substituting "technologue."
And he further moves that the French version of subsection 14(3) of the bill be amended by striking out "technicien" in the fourth line and substituting "technologue."
Motion agreed to.
Section 14, as amended, agreed to.
L'article 14, modifié, est adopté.
Sections 15 and 16 agreed to.
Les articles 15 et 16 sont adoptés.
Section/article 17:
The Chair: Shall section 17 stand as part of the bill? All those in favour? Any opposed?
Section 17 deleted.
L'article 17 est rayé.
Sections 18 to 20, inclusive, agreed to.
Les articles 18 à 20, inclusivement, sont adoptés.
Section/article 21:
The Chair: Mr Wessenger moves that section 21 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
And that this be stood down until October 21.
Motion to stand down. All those in favour?
Motion agreed to.
Section/article 22:
The Chair: Mr Wessenger moves that the French version of section 22 of the bill be amended by striking out "techniciens" and substituting "technologues."
Motion agreed to.
Section 22, as amended, agreed to.
L'article 22, modifié, est adopté.
Title/titre:
The Chair: Mr Wessenger moves that the French version of the long title of the bill be amended by striking out "technicien" and substituting "technologue."
Motion agreed to.
The Chair: Shall the title, as amended, carry? All those in favour? Any opposed?
Title, as amended, agreed to.
Le titre, modifié, est adopté.
The Chair: That is as far as we can go today on Bill 48. Section 21 has been stood down and we will complete the bill when we complete that section.
DENTISTRY ACT, 1991 / LOI DE 1991 SUR LES DENTISTES
The Chair: Are we ready to proceed? Did I have a request for a recess, Mr Hope?
Mr Hope: My arm is getting a little sore.
Sections 1 to 3, inclusive, agreed to.
Les articles 1 à 3, inclusivement, sont adoptés.
Section/article 4:
The Chair: We have several amendments to section 4. I am going to ask that all the amendments be placed first, since they seem to be very similar.
Mr Wessenger moves that paragraph 1 of section 4 of the bill be struck out and the following substituted:
"1. Communicating a diagnosis identifying a disease or disorder of the oral-facial complex as the cause of a person's symptoms."
And he further moves that section 4 of the bill be amended by adding the following paragraph:
"5.1 Applying or ordering the application of a prescribed form of energy."
Do you want to speak to your amendment or allow the others to comment first? We have other amendments that are similar.
Mr Wessenger: I wonder whether they are going to proceed with those.
Mr Beer: I would like to withdraw our amendment as it is the same as the government amendment.
Mr J. Wilson: I too would withdraw the PC amendment. It is very similar to the government amendment.
The Chair: I think we can assume this vote is going to be unanimous.
Mr Wessenger: This amendment removes the word "dysfunction" from the diagnosis authorized act in accordance with the act in Bill 43. It also authorizes dentists to apply or order the application of a prescribed form of energy which the dentists asked for. We felt it should be in the bill.
Motion agreed to.
The Chair: Mr Wessenger moves that paragraph 7 of section 4 of the bill be amended by inserting after "orthodontic" in the second line "or periodontal."
Motion agreed to.
Section 4, as amended, agreed to.
L'article 4, modifié, est adopté.
Section 5 agreed to.
L'article 5 est adopté.
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Section/article 6:
The Chair: Mr Wessenger moves that clause 6(1)(a) of the bill be amended by striking out "at least ten and no more than fourteen" in the first line and substituting "at least ten and no more than twelve."
And he further moves that clause 6(1)(b) of the bill be amended by striking out "at least six and no more than eight" in the first line and substituting "at least nine and no more than eleven."
And he further moves that clause 6(1)(c) of the bill be struck out and the following substituted:
"(c) two persons selected in the prescribed manner from among members who are members of a faculty of dentistry of a university in Ontario."
Mr Wessenger: This again changes the council composition to make public members just under half.
Mr J. Wilson: I will be voting against the government's amendment. We believe the amendment erodes the principle of self-government and we had put forward an amendment earlier which would have given a 60-40 split in terms of professional members versus lay members on the council.
Mr Hope: I will be supporting the amendment as put forward. I think it adds light with more of the general public being actively involved and understanding what this legislation is intended to do. I still believe it gives the right to self-governance.
The Chair: Shall the amendment carry? All those in favour? Those opposed?
Motion agreed to.
Section 6, as amended, agreed to.
L'article 6, modifié, est adopté.
Section 7 agreed to.
L'article 7 est adopté.
Section/article 8:
The Chair: Shall section 8 stand as part of the bill? All those in favour? Those opposed?
Section 8 deleted.
L'article 8 est rayé.
Sections 9 to 14, inclusive, deleted.
Les articles 9 à 14, inclusivement, sont rayés.
Section 15 agreed to.
L'article 15 est adopté.
Section/article 16:
The Chair: Mr Wessenger moves that subsection 16(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines. We have heard discussion on this before. All those in favour? Any opposed?
Motion agreed to.
Section 16, as amended, agreed to.
L'article 16, modifié, est adopté.
Section/article 17:
The Chair: Shall section 17 stand as part of the bill? Those in favour? Those opposed?
Section 17 deleted.
L'article 17 est rayé.
Sections 18 and 19 agreed to.
Les articles 18 et 19 sont adoptés.
Section/article 20:
The Chair Mr Wessenger moves that section 20 of the bill be amended by striking out "college" in the third line and substituting "council" and by striking out clause (c).
Motion agreed to.
Section 20, as amended, agreed to.
L'article 20, modifié, est adopté.
Section 21 agreed to.
L'article 21 est adopté.
Section/article 22:
The Chair: Mr Wessenger moves that the French version of subsection 22(1) of the bill be amended by inserting after "est" in the first line "le conseil de."
Motion agreed to.
Section 22, as amended, agreed to.
L'article 22, modifié, est adopté.
Section 23 agreed to.
L'article 23 est adopté.
Section/article 24:
The Chair: Mr Wessenger moves that section 24 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health
professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
And that this be stood down until October 21.
The Chair: There is a motion to stand down. All those in favour?
Motion agreed to.
Section 25 agreed to.
L'article 25 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: We have gone as far as we can on Bill 49 and hope to complete that on October 21, if possible.
DENTURISM ACT, 1991 / LOI DE 1991 SUR LES DENTUROLOGUES
Section/article 1:
The Chair: Mr Wessenger moves that the French version of section 1 of the bill be amended,
(a) by striking out "denturologues" in the definition of "ordre" and substituting "denturologistes"; and
(b) by striking out "denturologue" in the definition of "profession" and substituting "denturologiste."
Motion agreed to.
Section 1, as amended, agreed to.
L'article 1, modifié, est adopté.
Section/article 2:
The Chair: Mr Wessenger moves that the French version of subsection 2(2) of the bill be amended,
(a) by striking out "denturologues" in the definition of "ordre" and substituting "denturologistes"; and
(b) by striking out "denturologue" in the definition of "profession" and substituting "denturologiste."
Motion agreed to.
Section 2, as amended, agreed to.
L'article 2, modifié, est adopté.
Section 3 agreed to.
L'article 3 est adopté.
Section/article 4:
The Chair: Mr J. Wilson moves that section 4 of the bill be amended by adding the following subsection:
"(2) Despite subsection (1), a member is not authorized to fit or dispense partial dentures except on the order or prescription of a member of the Royal College of Dental Surgeons of Ontario."
Mr J. Wilson: I ask support from committee members on this amendment. Our concern is one of public protection, in the sense that we are very worried that people will now go to their denturists for primary dental care, that the first stop they will make is at the denturist's office rather than have a complete oral examination by a dentist. We believe and argue that those seeking dentures -- it certainly was the contention of many of the dental professionals who appeared before this committee -- should be subject to a full examination by a dentist, whether they are going for either full or partial dentures.
There has been some evidence of harm, I gather, by denturists performing partial dentures illegally in the past. That has been disputed. All members of the committee are aware of the long-standing debate in this area. In my remarks here, we are clearly taking the side of the evidence put before us by the dentists in this area at this time. Again, we believe the protection of the public should be of paramount interest here.
Mr Beer: We will not be supporting the amendment put forward by my colleague. I think we all accept that this was one of the more difficult issues. Frankly, we found the evidence put forward on this by Mr Schwartz, the commissioner, to be compelling. We believe the new College of Denturists of Ontario will be able to apply rules and procedures which will ensure that the public is protected. I think we all recognize that whether it is dentists or denturists or any profession, no single piece of legislation can ultimately ensure that nothing will go wrong at some point in time. In our view, in the light of the principles by which we are trying to protect the public and also provide for a broader range of service, the denturists are at a point in the development of their own profession where this can stand as originally put forward in the legislation. We will support the legislation as written and not support this amendment.
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Mr Wessenger: We will also be opposing this amendment, based on some of the reasons given by Mr Beer with respect to the testimony of Mr Schwartz, who indicated there was no evidence of any harm being done. Also, I think there is a certain illogical aspect to requiring a dentist's approval for a partial plate when there is not even a requirement for a full plate. I think members of the public clearly understand when they go to a denturist that they are not going to have their mouth looked at for determining its health. If that is their concern, they will go to a dentist. I do not think there is any harm to the public in this area. It would be an additional unnecessary expense to the public with no benefit.
Mr Owens: I have some sympathy for the amendment put forward by Mr Wilson. What I cannot wrap my mind around is the issue of access and the difficulties that may accrue by keeping dentists as the gatekeepers to denturists. I have spoken with members of both associations and in my mind I think we should dispense some free advice to both colleges. As the colleges are set up and as they mature in their relationship, they should begin to work in a collegial manner rather than the combative manner we have seen through the deputations and testimony, because I think there is an issue to be made with respect to good oral care. But I think that will be set forward in a co-operative manner rather than in a legislative manner.
Mr J. Wilson: Just in final argument, if you as legislators do not accept that there has been some evidence of harm from denturists constructing partial dentures in the past, surely you would accept the argument that there is great potential for harm in the future, if you give them this controlled act. I think we should err, if we are erring, on the side of public protection. The parliamentary assistant mentioned extra expense in requiring patients to go to a dentist before going to a denturist. The logic there is inconsistent with the same logic we applied to audiologists and speech-language pathologists, where we require patients to go to audiologists and speech-language pathologists as the primary point of entry for hearing aids. We have passed that bill so far in our hearings. We did that because we wanted to ensure the public was protected, as I understand it.
The parliamentary assistant mentioned that there was something illogical about denturists being able to perform full dentures but not partials. I think the case was made very clear by dentists that they have the training and medical background required and that more of a medical background is required before one actually starts tampering with teeth that remain in the mouth and adding partial dentures or affixing partial dentures to those teeth. There is a difference between a case where there are no teeth and a case where there are teeth. That is the crux of the argument we are having here right now.
Mr Owens: Just as a quick comment around cost, I think the issue the parliamentary assistant may have been trying to raise with respect to cost is that not all people have dental plans and that there are people who fall between the cracks. As I understand it from conversations with constituents, some of the municipalities are getting out of the business of providing dental care through general welfare assistance or family benefits, so you are looking at people who are going to fall between the cracks. How can we get those people into good dental care? I know there are professionals out there who practise social dentistry and who are willing to give patients a break, but how do you encourage that kind of activity? Do you legislate it or do you try and use moral suasion on people and hope they will give them a break?
Mr J. Wilson: If we are sending people there as the primary entry and we are allowing them to get partial dentures, a concern that was expressed by many professionals was that they may not recognize certain diseases, such as the early stages of AIDS, gum diseases and other diseases of the mouth. Cancer, for instance, was brought to our attention. We may have to increase the training for denturists, which I see eventually driving up the cost of that service because they are going to have to have a more complete medical background to be able to properly look after those people who will now rely on them as their primary entry to dental services.
Ms Haeck: In my capacity as an MPP, I have had the opportunity to meet with constituents whom I asked to write to this committee because they were very concerned about dentistry practised in St Catharines-Brock. They felt very positively towards their denturist and had some rather negative feelings towards their dentist. The reality of practice out there, as well as what this act would set out to do, is that dentists have the right, the opportunity, to carry on the large field of dental care and denturists are obviously restricted in what they can do around the providing of plates, partial or complete, as per this legislation. From what I have seen out there, this is something the public feels very positively towards and I must concur with that wish.
Mr Beer: I would like to return us all to a couple of other points we are trying to meet with the legislation. One is that we are dealing with two professional groups here. I think that in the light of what Mr Owens said earlier, in a number of areas we are going to have professional groups involved in health care coming together and working together.
It seems to me that the new councils we are creating, and this is one good example, will be leaning over backwards to ensure that the fundamental procedures they set up are going to really focus on protecting the public. I think we can rely on the judgement of both those groups to do that. In many communities -- I think of my own -- the relationship between dentists and denturists is a very positive one. I would see that in the normal course, as this works its way out, that would continue to be the case.
The final point I would make covers a great many of the things we are doing here. The consumer also has a responsibility. I think we can go to a certain point in protecting the public, but fundamentally and ultimately in many of these areas we are going to have to be looking at improved education to the consumer about health care services. I think each of us and our friends in our own communities has a responsibility to do that as well. Again, it is a balance we are trying to find and I think that is what we have found in terms of the original legislation.
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Mr J. Wilson: I have just some final remarks, and I promise they are final, Madam Chair, because I believe most members by their remarks have decided how they are going to vote at this stage. I would say in response to Ms Haeck's comments that a couple of denturists appeared before our committee who certainly would have no problem with our amendment. They had been working, as Mr Beer said, co-operatively for years in the community with the dentists. The dentist at one end of the building does the full examination and writes the prescription or order for fitting of dentures, and the patients then go down and have the technical work done by the denturist. I see that as a good system, a co-operative system, and that was the intent of my amendment.
Mr Wessenger: I think there is some indication that the dentists and the denturists will be able to work well together. Certainly there was evidence of that, as you said, Mr Tilson, in some of the appearances before the committee. But I think we should also remember that each profession has its own quality assurance programs and its own competency standards, so these will be developed by the denturists. I have confidence that those standards, as developed, will give good guidance to have good-quality care with respect to the provision of partial denture plates. I am sure part of that is that it would be a policy of the denturist to ensure that anyone who might have a health problem would be referred to the proper person, whether that would be a medical doctor or a dentist. So I am confident that will be worked out through the quality assurance program for the denturists.
The Chair: All those in favour of the amendment? Those opposed?
Motion negatived.
Section 4 agreed to.
L'article 4 est adopté.
Section/article 5:
The Chair: Mr Wessenger moves that the English version of section 5 of the bill be amended by striking out "denturologues" in the fourth line and substituting "denturologistes."
And he further moves that the French version of section 5 of the bill be amended by striking out "denturologues" in the third line and substituting "denturologistes."
Motion agreed to.
Section 5, as amended, agreed to.
L'article 5, modifié, est adopté.
Section/article 6:
The Chair: Mr Wessenger moves that clause 6(1)(a) of the bill be amended by striking out "at least eight and no more than ten" in the first line and substituting "at least seven and no more than eight."
And he further moves that clause 6(1)(b) of the bill be amended by striking out "four or five" in the first line and substituting "at least five and no more than seven."
Ms Haeck: I just wanted to get ahead of Mr Wilson. The torch has been passed from Mr Hope to myself. We strongly feel that this amendment supports the concept of public involvement and definitely gives the college self-governing status.
The Chair: You are not going to disappoint Ms Haeck, are you, Mr Wilson?
Mr J. Wilson: I was going to say, "I fooled you," but none the less I guess my comments are on the record from previous such motions put forward by the government. We will be opposing this, not because we do not believe the public is an integral part of the system; we just also believe you have to have a little more trust in the self-regulating principle.
The Chair: Shall the amendment carry? All those in favour? Those opposed?
Motion agreed to.
Section 6, as amended, agreed to.
L'article 6, modifié, est adopté.
Section 7 agreed to.
L'article 7 est adopté.
Section/article 8:
The Chair: Shall section 8 stand as part of the bill? All those in favour? Those opposed?
Section 8 deleted.
L'article 8 est rayé.
Sections 9 to 14, inclusive, deleted.
Les articles 9 à 14, inclusivement, sont rayés.
Section/article 15:
The Chair: Mr Wessenger moves that subsection 15(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Mr J. Wilson: I would just like to commend the government on bringing forward this amendment for each of the bills before us.
The Chair: Any further debate?
Mr J. Wilson: I thought, Madam Chair, I should say something positive for a change. This is the one opportunity I have to do that.
The Chair: Duly noted.
Mr Owens: Put that in a press release.
Mr J. Wilson: Put that in your press release.
Motion agreed to.
The Chair: Mr Wessenger moves that the French version of subsection 15(1) of the bill be amended by striking out "denturologue" in the second line and substituting "denturologiste."
And he further moves that the French version of subsection 15(3) of the bill be amended by striking out "denturologue" in the fourth line and substituting "denturologiste."
Motion agreed to.
Section 15, as amended, agreed to.
L'article 15, modifié, est adopté.
Sections 16 and 17 agreed to.
Les articles 16 et 17 sont adoptés.
Section/article 18:
The Chair: Shall section 18 stand as part of the bill? All those in favour? Those opposed?
Section 18 deleted.
L'article 18 est rayé.
Sections 19 to 21, inclusive, agreed to.
Les articles 19 à 21, inclusivement, sont adoptés.
Section/article 22:
The Chair: Mr Wessenger moves that section 22 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Mr Wessenger: I would ask to stand this down until October 21.
The Chair: Stand this down until October 21.
Section/article 23:
The Chair: Mr Wessenger moves that the French version of section 23 of the bill be amended by striking out "denturologues" in the second line and substituting "denturologistes."
Motion agreed to.
Section 23, as amended, agreed to.
L'article 23, modifié, est adopté.
Title/titre:
The Chair: Mr Wessenger moves that the French version of the long title of the bill be amended by striking out "denturologue" and substituting "denturologiste."
Motion agreed to.
Title, as amended, agreed to.
Le titre, modifié, est adopté.
DIETETICS ACT, 1991 / LOI DE 1991 SUR LES DIÉTÉTISTES
Sections 1 to 4, inclusive, agreed to.
Les articles 1 à 4, inclusivement, sont adoptés.
Section/article 5:
The Chair: Mr Wessenger moves that clause 5(1)(a) of the bill be amended by striking out "at least eight and no more than twelve" in the first line and substituting "at least six and no more than nine."
And he further moves that clause 5(1)(b) of the bill be amended by striking out "at least four and no more than six" in the first line and substituting "at least five and no more than eight."
The Chair: All those in favour? All those opposed?
Motion agreed to.
Section 5, as amended, agreed to.
L'article 5, modifié, est adopté.
Section 6 agreed to.
L'article 6 est adopté.
Section/article 7:
The Chair: Shall section 7 stand as part of the bill? All those in favour? All those opposed?
Section 7 deleted.
L'article 7 est rayé.
Sections 8 to 13, inclusive, deleted.
Les articles 8 à 13, inclusivement, sont rayés.
The Chair: Mr Wessenger moves that subsection 14(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Mr J. Wilson: Members will note that on the next page my amendment to this subsection goes a little further in extending further title protection. I certainly would urge members to vote in favour of the government's amendment, which would drop the last half-sentence of my amendment, and then vote for the PC amendment following.
Motion agreed to.
The Chair: Mr J. Wilson moves that the first part of subsection 14(1) of the bill be struck out and the following substituted:
"(1) No person other than a member shall use the title `dietitian' or `dietitian nutritionist', a variation or abbreviation or an equivalent in another language."
Mr Wessenger: I would speak in opposition to this motion, because the title "dietitian nutritionist" is not in common use and restricting the word "nutritionist" would interfere with nutritionists who are not members of the college. I think the public would also be confused by the fact that you would have both the titles "dietitian" and "dietitian nutritionist."
Mr Beer: We would not support this particular amendment. We believe the title "dietitian" would be sufficient.
The Chair: Is there any further discussion of the amendment? All those in favour? Those opposed?
Motion negatived.
Section 14, as amended, agreed to.
L'article 14, modifié, est adopté.
Sections 15 and 16 agreed to.
Les articles 15 et 16 sont adoptés.
Section/article 17:
The Chair: Shall section 17 stand as part of the bill? All those in favour? Any opposed?
Section 17 deleted.
L'article 17 est rayé.
Sections 18 and 19 agreed to.
Les articles 18 et 19 sont adoptés.
Section/article 20:
The Chair: Mr Wessenger moves that section 20 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the Health Professions Procedural Code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Mr Wessenger: I ask that this be stood down until October 21.
The Chair: Motion to stand down. We will do that.
Section 21 agreed to.
L'article 21 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: I have had a request for a five-minute recess, at which time we will commence on Bill 52.
The committee recessed at 1705.
1711
The Chair: The standing committee on social development is now in session. Are we ready to proceed? You would be a welcome addition to the committee.
Mr J. Wilson: I am a little worried about the colour she is wearing.
The Chair: That did not prompt my comment at all, Mr Wilson. You know how impartial the Chair is on these matters. Do you think we can proceed without Mr Hope?
Mr J. Wilson: Yes, he is hopeless anyway.
The Chair: Now, Mr Wilson, Hansard will not record that.
Mr J. Wilson: I do not care whether they do or not.
The Chair: Are you ready to proceed?
Mr Owens: Let me count my votes here.
MASSAGE THERAPY ACT, 1991 / LOI DE 1991 SUR LES MASSOTHÉRAPEUTES
The Chair: We are dealing now with Bill 52, An Act respecting the regulation of the Profession of Massage Therapy.
Sections 1 and 2 agreed to.
Les articles 1 et 2 sont adoptés.
Section/article 3:
The Chair: Mr Wilson moves that section 3 be struck out and the following substituted:
"(3) The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissues and joints to develop, maintain, rehabilitate or augment physical function, or to avoid or relieve pain, by manipulation of the soft tissues and mobilization of the joints."
Mr J. Wilson: The purpose of the amendment is to clarify what it is that massage therapists actually do, in particular with respect to their role as opposed to the role of a chiropractor. We believe that the scope of practice as outlined in the PC amendment much more clearly reflects the function and scope of practice of a massage therapist and would ask members to support the amendment.
Mr Wessenger: I would like to oppose the amendment. I think the language is quite clear with respect to manipulation, and I do not know exactly what the word "mobilization" means. In my opinion the massage therapists do in fact manipulate joints in their scope of practice, and that should be the language that should be used, not another word which is less clear.
Mr Beer: I have had, and I think we have had, difficulty in understanding this amendment in the context of what is in the proposed bill, and therefore would prefer to support section 3 as it now stands. There may well be a number of issues such as this where perhaps we want to come back to the role of the advisory council. If there is some doubt as to what certain things mean, in trying to find the essential difference in the two and with the word "manipulation" in both, I do not see that.
Given what we have gone through and in the discussions with the various groups, in our judgement we should go with what is in the present bill but perhaps here, as in a number of other places, ask the advisory council to work together with the councils on massage therapy and chiropractic if it appears down the road that we need some clearer wording, or if there is some confusion to try to sort that out. At this point in time we are not persuaded by my colleague's proposed amendment.
Mr Owens: I would like to agree wholeheartedly with Mr Beer that with the word "manipulation" appearing in two other acts, that is, the chiropractors' and the osteopaths', one would look for some guidance from the advisory council on manipulation within the scopes of practice. The other thing is that I was under the understanding that these two groups had perhaps worked out their concerns with each other, but I guess that is not the case. I would encourage these groups, as Mr Beer has done, to sort out the differences around the term "manipulation" through the interim advisory committee and their colleges.
Mr J. Wilson: Contrary to what the parliamentary assistant has stated, it is certainly my understanding that chiropractors manipulate joints and that massage therapists manipulate soft tissues and mobilize joints. The terminology is extremely important to the professions. I suspect that the advisory council will never really get around to dealing with this matter and I think legislators have a responsibility to ensure that the wording is as clear as possible before it leaves this committee and is sent to the House for final approval.
The Chair: Further discussion on the amendment? All those in favour? Those opposed?
Motion negatived.
Section 3 agreed to.
L'article 3 est adopté.
Section 4 agreed to.
L'article 4 est adopté.
Section/article 5:
The Chair: Mr Wessenger moves that clause 5(1)(a) of the bill be amended by striking out "at least seven and no more than eight" in the first line and substituting "at least six and no more than seven."
And he further moves that clause 5(1)(b) of the bill be amended by striking out "four" in the first line and substituting "five."
The Chair: To the amendment, all those in favour? Any opposed?
Motion agreed to.
Section 5, as amended, agreed to.
L'article 5, modifié, est adopté.
Section 6 agreed to.
L'article 6 est adopté.
Section/article 7:
The Chair: Shall section 7 stand as part of the bill? All those in favour? Those opposed?
Section 7 deleted.
L'article 7 est rayé.
Sections 8 to 13, inclusive, deleted.
Les article 8 à 13, inclusivement, sont rayés.
The Chair: Mr Wessenger moves that subsection 14(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Motion agreed to.
Section 14, as amended, agreed to.
L'article 14, modifié, est adopté.
Sections 15 and 16 agreed to.
Les articles 15 et 16 sont adoptés.
Section/article 17:
The Chair: Shall section 17 stand as part of the bill? Those in favour? Those opposed?
Section 17 deleted.
L'article 17 est rayé.
Sections 18 to 20, inclusive, agreed to.
Les articles 18 à 20, inclusivement, sont adoptés.
Section/article 21:
The Chair: Mr Wessenger moves that section 21 of the bill be amended by adding the following subsection:
(4) Despite subsection (1), sections 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force.
Mr Wessenger: I ask to stand this down until October 21.
The Chair: Stood down until October 21.
Section 22 agreed to.
L'article 22 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: I believe we have had an agreement to go as far as Bill 52 today, unless there is a desire to do Bill 53.
Interjection.
The Chair: We are not ready? I would request that any amendments on the next set of bills be tabled with the clerk by Thursday, if that is possible. The clerk has informed me that she is going to be involved with the constitutional conference and will not be available to receive the amendments on Friday.
As we will be dealing next Monday with many of those items that have been stood down, I doubt we will get through very many more of the bills on that day. Has there been an agreement among the whips as to how far we should attempt to proceed next week?
Mr J. Wilson: There has been no agreement to date, but I think it would be reasonable to expect, since Monday will be taken up with other arguments, that we could probably proceed on Tuesday with the next four bills.
The Chair: Agreed? Agreed. We will have the amendments on the next four bills to the clerk from the caucuses by Thursday.
The committee adjourned at 1722.